There are many Paper (for example, Parisi P et al. Dev Med Child Neurol 2010) whose results are in favor of the treatment in these patients.

Particularly in cases with diffuse EEG discharges during sleep (which can reach sometimes an ESES condition) and cognitive impairment, in my opinion it could be a good idea to try 6-12 months of treatment. Obviously, it is mandatory to perform cognitive tests (before and during the AEDs treatment) in order to see if it is worth continuing.

Pasquale Parisi

I am agree with professor Parisi and I believe that the presence of continuous discharges associated with a significant cognitive impairment are valid criteria for start a treatment

Thanks.

I invite you to few papers published by me in Clin Neurol Neurosurg that show concordance with your opinions and also challenge the prevalent belief that CP is a non-progressive motor disorder, which is important to bear in mind when managing the patients with CP.

Dear Colleague Dr. Jaseia, as we all know the Cerebral Palsy conditions can be considered as "non-progressive" disorders just from the "lesional" and "temporal" point of view ( noxae acting in a specific developmental period : from early peri-natal to infancy) .

Viceversa, from the "functional", "developmental" and "psychomotor/behavioral" points of view, acting the noxae in a developing organism (from neonatal to childhood), CP must be considered in any case a "progressive" disorder. That's why, by definition, a "non-progressive" lesion can interfere with a "developmental status" in many ways. In addition, this "progressive" condition (from a developmental point of view !) can be even worsened due to concomitant and additional negative effect on the cognitive performance (which are sleep-related) caused by EEG-abnormalities on sleep physiology (see for example the ESES conditions).

So I completely agree with You, but we have to be carefull why this message can be misunderstood and lead to overtreatment.

In conclusion, as I told You before, I think that we should perform cognitive tests (before and during the AEDs treatment) in order to see if it is worth continuing.

Pasquale Parisi

Sygkliti Henrietta Pelidou

Continious discharges associated with cognitive impairment are worth criteria to start AEDs treatment and detect if there were be any alterations in patients' cognition

Let me introduce myself: I am Dr Tatiana Maykova, and run a private clinic in Kyiv, Ukraine, specialised in functional disorders of the brain, including epilepsy, headache etc.

In my experience, EEG testing is the only realistic method of measurement of brain excitement in real time. However, we still haven't understood the clinical relevance of EEG scanning.

Angela, when I read your post I recalled that our neurologists rarely like to use valproic acid in their younger patients, though the risk may be more specific to those with mitochondrial disease. Valproate can be a very good drug and is sometimes well tolerated even in high doses, but the worry is with hepatotoxicity. See http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm360487.htm re POLG disease, and for more general information about use in youg children, see http://professionals.epilepsy.com/medications/p_depakene_children.html.

That said, if they know the specific syndrome or etiology of the seizures it may be a perfectly fine choice though. Does he also have CP or other developmental delays?